oral surgery and orthodontics

Question 1

soft tissue pathology

Answer 1

frenums
impacted canines
impacted premolar exposures

Question 2

soft tissue pathology - frenums

Answer 2

frenectomy
frenoplasty - nowadays usually modify rather than remove
- V to Y
- Z-plasty

Question 3

soft tissue pathology - impacted canines

Answer 3

usually buccally placed canines if no bone covering
buccal apically repositioned flap
palatal open exposure

Question 4

soft tissue pathology - impacted premolar exposures

Answer 4

often L just ST

Question 5

hard tissue pathology

Answer 5

impacted canines
impacted premolars
other extractions
submerged retained deciduous teeth
implants
mini-implants
orthognathic surgery

Question 6

hard tissue pathology - impacted canines

Answer 6

buccal apically repositioned flap with bone removal
palatal open exposure with bone removal
buccal or palatal closed exposure with gold chain attachment
extraction

Question 7

hard tissue pathology - impacted premolars

Answer 7

extraction
exposure with bone removal
often if early loss of Es - usually lingual or in line of arch

Question 8

most common procedure

Answer 8

impacted canines

Question 9

tx options for impacted canines

Answer 9

leave and monitor - relieve crowding and may spontaneously erupt (buccally)
extract canine
surgical exposure and ortho alignment 
 - open or closed exposure (gold chain)
 - mini implants
 - corticotomy
transplant

Question 10

potential consequences of leaving and monitoring impacted canines

Answer 10

root resorption
dentigerous cyst
interfere with implant placement

Question 11

indications for extracting impacted canine

Answer 11

if v high/bad position

if can achieve adequate aesthetics e.g. camouflaging 4 as a 3

Question 12

minimal surgical exposure of impacted canine in line of arch

Answer 12

extract c
remove overlying mucosa and follicle - don’t need to raise flap, just excise ST
remove any overlying bone with Rougeurs
place Whitehead’s varnish gauze pack
- to stop ST just growing back
horizontal mattress suture
- avoid knot on palatal as can annoy tongue
can then bond erupting canine onto ortho appliance - could place bracket on when remove pack if concerned ST will grow over

Question 13

where do buccally placed canines tend to erupt?

Answer 13

in unattached mucosa

Question 14

where do palatally placed canines tend to erupt?

Answer 14

in attached mucosa

Question 15

why is it a problem that buccally placed canines tend to erupt in unattached mucosa?

Answer 15

if you just incise and pull tooth down it will bring unattached mucosa down - can cause aesthetic problems

Question 16

buccally placed canines pros and cons

Answer 16

good access

aesthetic result may not be as good as palatal

Question 17

which type of mucosa do you not want to cut away?

Answer 17

attached mucosa

Question 18

apically repositioned flap

Answer 18

preserve attached mucosa
x2 nearly parallel relieving incisions and a crestal incision - 3 sided flap
fold flap on itself
suture at neck of canine
can leave uncovered or place coe pack/whitehead varnish - granulates quickly, will be sore for a few days
canine will pull attached mucosa back down as it comes down

Question 19

indications for canine transplant

Answer 19

cannot reasonably get a result by exposure and traction
potential for damage to other teeth
space is available or can be made available without premolar ext
older pt who is seeking a quick fix

Question 20

canine transplant procedure

Answer 20

exposure of surgical site
remove canine - place in sulcus/physiologic saline to preserve PDL
prepare bone - drill to fit canine in socket fully
place canine in anatomical position - but no bone palatally as where canine used to be
close flap with sutures
Ti trauma splint (prev CoCr cap splint)
- semi-rigid - want to give PDL cells some physiologic loading
- usually 1 tooth either side - more teeth makes it too rigid
- 1-2 wks
then pulp extirpation and RCT

Question 21

risk to warn pt re canine transplant

Answer 21

risk of ankylosis

but can still last a long time e.g. 30 years

Question 22

luxation

Answer 22

prev used to luxe canine to encourage it to erupt

not done now as encourages ankylosis

Question 23

kissing canines

Answer 23

one canine across line of arch, touching other canine

Question 24

dilacerated canines

Answer 24

can be difficult to ortho realign due to hook on root

may need ext

Question 25

submerged deciduous teeth

Answer 25

ankylosed - adjacent teeth have grown around it
often needs sectioning to remove
- can damage permanent successor

Question 26

fraenectomies

Answer 26

frenum has opportunistically grown into space - now don’t believe it is the cause of a diastema
may remove post-tx for aesthetics/cleansing/scarring may help stability and prevent relapse
cut it out
suture resultant defect
would need pack between incisor teeth as cant suture here

Question 27

V to Y frenoplasty

Answer 27

incise frenum V and cut out middle
stitch the centres and pull - get a Y shape
do a less aggressive technique nowadays

Question 28

Z-plasty

Answer 28

no longer done
scarring from surgery - contraction - get reduction in size of frenum even though no removal of tissue
make a Z cut and flip two flaps round then suture

Question 29

implants for ortho tx

Answer 29

planned moment of tooth/group of teeth causes reciprocal movement of the teeth used for anchorage during tx
implant osseointegrated
SS mini-implants

Question 30

how do implants provide qualities of an ideal ortho anchor

Answer 30

pt compliance unnecessary
absolute anchorage as no PDL
easily used under variety of tx modalities
easily placed
removable if necessary

Question 31

SS mini-implants

Answer 31

don’t osseointegrate but screw in with friction
self-tapping screw - don’t need drill
eventually exfoliate after 1-2 years
no healing - just remove and leaves tiny defect
be careful that you don’t place them into a root

Question 32

palatal mini-implant

Answer 32

be careful you don’t end up in floor of nose

can take a lot of loading

Question 33

corticotomy

Answer 33

can facilitate tooth movement - weaken buccal and palatal bone
drill gutters and into bone
teeth will move more quickly and roots don’t resorb
can be a good last resort but rare